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Biomedical subjects

J R Zahar

Publications and source records attributed to J R Zahar.

8 recordsLinked to original sources
PubMed2002

Pneumocystis carinii pneumonia in critically ill patients with malignancy: a descriptive study.

There are few data on Pneumocystis carinii pneumonia (PCP) in critically ill human immunodeficiency virus (HIV)-negative patients. Improved knowledge of the presenting symptoms of and prognostic factors for PCP may help to reduce the high mortality rate associated with PCP in such patients. We retrospectively studied 39 consecutive patients with acute PCP-related respiratory failure and malignancy who were treated at 2 intensive care units (ICUs) during a 10-year period. Univariate logistic regression identified the following 8 predictors of mortality at 30 days after patient admission to the ICU (30-day mortality rate, 33%): complete remission of the malignancy (odds ratio [OR], 0.18), receipt of >1 course of antimalignancy chemotherapy (OR, 17.2), involvement of 4 lobes noted on a chest radiograph (OR, 5), >15% neutrophils in bronchoalveolar lavage [BAL] fluid specimens (OR, 6), Organ System Failure score (OR, 7.33), Simplified Acute Physiology Score II (OR, 1.12), and the need for either mechanical ventilation (OR, 63) or vasopressors (OR, 25.9). Studies are needed to determine whether aggressive monitoring and treatment of patients with >15% neutrophils in BAL fluid specimens can improve the outcome of critically ill patients with malignancy and PCP.

Acute Disease↗
PubMed2002

[Paucisymptomatic and reversible myelinolysis after an anaphylactic shock].

Myelinolysis is characterized by a non inflammatory demyelination, affecting the central portion of the pons. Clinical features usually reflect damage to the descending motor tracts and include spastic tetraparesis, pseudobulbar paralysis, and the locked-in syndrome. We describe the case of a 58-year-old man, who developed a pontine and extrapontine myelinolysis, without hyponatremia, after an anaphylactic shock. Follow up demonstrated improvement of the clinical signs after a few days and the normalization of the MRI three months later. Our observation shows that a paucisymptomatic and spontaneously regressive myelinolysis can be the consequence of a state of shock.

Anaphylaxis↗
PubMed2001

[Dermo-hypodermitis and necrotizing fasciitis].

Acute gangrenous dermo-hypodermitis and necrotizing fasciitis are potentially life-threatening infections of skin and soft tissues, which may be difficult to recognize at an early stage. A combination of local signs (erythema, mottling, bullous formation) and of symptoms suggestive of sepsis should prompt early suspicion and therapeutic intervention. Group A streptococci remain the major pathogen involved in necrotizing fasciitis involving extremities, following minor trauma or surgery, and sometimes apparently spontaneously. The most severe form is streptococcal toxic shock syndrome, where production of exotoxins (superantigens) is a major factor contributing to the severity of the syndrome. A number of other pathogens, often combined in mixed aerobic-anaerobic infections may be involved, especially in post-surgical and perineal gangrene. Surgery remains the mainstay of therapy, and should be considered as soon as the clinical suspicion arises. Antibiotic therapy is based on penicillins (penicillin G for streptococcal gangrene, or beta-lactamases penicillins in polymicrobial infections). New therapeutic approaches (clindamycin and immunoglobulins) may be useful in streptococcal toxic shock. The prognosis appears to have improved in recent years with early therapeutic intervention, but remains largely dependent on the severity of the septic response and underlying diseases.

Anti-Bacterial Agents↗
PubMed2001

Delayed treatment contributes to mortality in ICU patients with severe active pulmonary tuberculosis and acute respiratory failure.

OBJECTIVES: To clarify the patterns of pulmonary tuberculosis (TB) that should result in a high index of suspicion, to increase the chances of early therapy and to identify predictors of 30-day mortality. PATIENTS AND METHODS: Retrospective, 7-year study in two medical intensive care units (ICUs). All patients admitted with pulmonary TB were enrolled. Clinical and laboratory data at admission and events within 48 h of admission were collected. Predictors of 30-day mortality were identified by univariate and multivariate analysis. RESULTS: The study included 99 patients with a median age of 41 years. Immunodeficiency was present in 60 patients, including 38 with AIDS. Fifty-nine patients had pulmonary TB alone, 22 also had extrapulmonary TB and 18 had miliary. All 99 patients were admitted for acute respiratory failure, some also with shock (20), neurologic disorders (18) or acute renal failure (10). Mechanical ventilation was needed in 50 patients; 22 patients met criteria for acute respiratory distress syndrome (ARDS). The 30-day mortality rate was 26.2%. Four factors independently predicted mortality: a time from symptom onset to treatment of more than 1 month (OR, 3.49; CI, 1.20-10.20), the number of organ failures (OR, 3.15; CI, 1.76-5.76), a serum albumin level above 20 g/l (OR, 3.96; CI, 1.04-15.10), and a larger number of lobes involved on chest radiograph (OR, 1.83; CI, 1.12-2.98). CONCLUSION: Delayed clinical suspicion and treatment of active pulmonary TB with respiratory failure may contribute to the persistently high mortality rates in ICU patients with these diseases.

Acute Disease↗
PubMed1999

Corticosteroids as adjunctive therapy for severe Pneumocystis carinii pneumonia in non-human immunodeficiency virus-infected patients: retrospective study of 31 patients.

The aim of this retrospective study was to assess whether corticosteroid adjunctive therapy (CAT) could prevent death in immunocompromised patients with severe Pneumocystis carinii pneumonia (PCP) who do not have human immunodeficiency virus (HIV) infection, similarly to what has been demonstrated for HIV-infected patients. The charts of all non-HIV-infected patients who were admitted to two medical intensive care units between 1988 and 1996 because of severe PCP, defined by an arterial oxygen pressure (determined while the patient was breathing room air) of <70 mm Hg, and who were treated with trimethoprim-sulfamethoxazole were analyzed retrospectively. Thirty-one patients met the study criteria, of whom 23 received CAT (within 72 hours of antibiotic therapy) and eight did not receive CAT. The need for mechanical ventilation (10 [43%] of 23 vs. 4 [50%] of 8) and the mortality rate (9 [39%] of 23 vs. 4 [50%] of 8) were similar for the two groups. Although this small study does not have a statistical power high enough to rule out the possibility of a difference, the results suggest that CAT does not improve the survival of non-HIV-infected patients as has been described for HIV-infected patients with severe PCP.

Adolescent↗
PubMed1993

Localized invasive pulmonary aspergillosis in patients with neutropenia. Effectiveness of surgical resection.

BACKGROUND: Invasive pulmonary aspergillosis (IPA) is a major cause of morbidity and mortality in patients with neutropenia. Two severe complications with poor outcome can be observed after apparently successful IPA medical treatment: severe hemoptysis and IPA relapse during subsequent cytotoxic treatments. Early surgical therapy has not been considered routinely in the management of localized IPA. METHODS: Six consecutive patients (four women, two men; median age, 52 years) with localized cavitating IPA diagnosed during chemotherapy-induced aplasia were treated with early surgical resection after hematologic recovery. RESULTS: All patients received a lobectomy. Surgery was uneventful. This procedures allows patients to proceed with further intensive chemotherapy and/or bone marrow transplantation without IPA reactivation. CONCLUSIONS: For selected patients, surgical resection of localized IPA with unique cavitating lesion, which prevents hemoptysis and IPA recurrence and allows for subsequent cytotoxic treatment, may be recommended.

Adult↗